Setting the balance of care for older adults at risk of hospitalization and delayed discharge: A mixed-methods research protocol

Abstract

Introduction: Delayed hospital discharge is a persistent care quality issue experienced across health systems worldwide and remains a priority area to be addressed in Canada. Often associated with a decrease in services while waiting to leave the hospital, delayed discharge from hospital can lead to increased frailty, physical and cognitive decline, and caregiver burnout. Optimizing availability of and timely access to community-based health and social care are avenues that could reduce initial admissions to the hospital and length of hospital stay, and facilitate hospital discharges.

Methods: This research will explore the ways in which community resources could be leveraged to potentially avoid hospitalization and delayed hospital discharge for older adults using sequential mixed-methods including co-design. To better understand the characteristics and needs of older adults, the research team will first identify sub-populations of older adults (65 years old or older) at risk of hospitalization and delayed discharge using comprehensive, longitudinal administrative health data. From these health data, risk profiles and personas will be created and then shared with key partners (e.g., older adults, caregivers, healthcare providers, healthcare decision-makers), who will be engaged to identify, leverage, and create targeted care solutions. The barriers and facilitators to the implementation of these care solutions will then be explored.

Discussion: Delayed hospital discharge has been a critical care quality issue across Canada for decades. The current research will provide health system leaders with an approach to better allocate services to older adults in order to avoid delayed hospital discharge and identify gaps in health and social care resources based on the characteristics, needs, and preferences of older adults, their caregivers, and providers.